885

LOVE, R. L., M.D., C.M., has been appointed Assistant Medical Officerto the York Friendly Societies’ Medical Association, at £150per annum and accouchement fees, vice Hannan, resigned.

MACKERN, W., M.D., M.R.C.S.E., has been appointed Medical Officerfor the Stapleford District of the Shardlow Union, Derbyshire, viceBland, whose appointment has terminated.

O’SULLIVAN, M. U., L.R.C.P.Ed., L.R.C.S.Ed., has been appointedMedical Officer, Public Vaccinator, &c., for the No. 1 Division ofthe Brosna Dispensary District of the Tralee Union.

OXLAND, Mr. R., has been appointed Public Analyst for the Boroughof Devonport, at 42s. for each statutory quarterly report, 10s. 6d. foreach analysis and certificate of food or water, and 10s. 6d. forattending as a witness.

SHEPPARD, H. H., M.R.C.S.E., has been appointed Medical Officer andPublic Vaccinator for the Mileham District of the Mitford andLaunditch Union, Norfolk, at 55 per annum and fees, vice Hazard,resigned.

STRONG, H. J., M.D., has been appointed Surgeon to the Croydon PostOffice.

SYMONDS, H. P., M.R.C.S.E., L.S.A.L., has been appointed a Surgeonto the Rtdcliffe Infirmary, Oxford, vice F. Symonds, F.R.C.S.E.,

resigned.WATSON, W. S., F.R.C.S.E., M.B., has been appointed a Surgeon to theGreat Northern Hospital, vice Jackson, deceased.

Births, Marriages, and Deaths.BIRTHS.

BEVAN.—On the 4th inst., at New Romney, the wife of Richard Bevan,L.R.C.P.L., of a son.

FERRIER. - On the 6th inst., at Upper Berkeley-street, the wife ofDavid Ferrier, M.D., of a son.

GREIG.-On the 3rd inst., at York-place, Clifton, the wife of CharlesGreig, F.R.C.S.Ed., of a daughter.

HERON.—On the 5th inst., at Margaret-street, Cavendish-square, thewife of George A. Heron, M.D., of a son.

KEALY.-On the 6th inst., at Ashley House, Gosport, the wife of JohnRobert Kealy, M.D., of a son.

MAXWELL. - On the llth inst., at Wellington House, Woolwich-common, the wife of Theodore Maxwell, M.D., of a daughter.

ROBERTSON.—On the 6th inst., at The Friarage, Penrith, the wife ofJ. D. Robertson, M.D., of a son.

MARRIAGES.BARK—LOVIBOND.—On the 12th inst., at Farnborough, Ernest 0. Bark,

L.R.C.P.L., M.R.C.S., of Aston-road, Birmingham, to Alice Mary,daughter of J. L. Lovibond, of Start’s-hill, Farnborough, Kent.

PARKINSON—HUNT.—On the 6th inst., at St. George’s, Hanover-square,by the Rev. W. E. Buckley, M.A., Rector of Middleton Cheney, andRural Dean, Richard Colville Parkinson, Surgeon, Army MedicalDepartment, second son of the late Rev. Richard Parkinson, M.A.,formerly Vicar of Northaw, Herts, to Edith Annie, third daughterof Thomas Hunt, Esq., of The Holt, Middleton Cheney, Northampton-shire.

PIERCE—PEARSON.—On the 6th inst., at Platt Chapel, Rusholme,Frederick Morrish Pierce, M.D., to Hannah Sophia, youngestdaughter of John Pearson, Esq.

DEATHS.ATKINSON.—On the 3rd inst., at Over, Cheshire, Thomas Atkinson,

Surgeon, in practice prior to 1815, aged 84.GILLARD.—ON the 4th inst., at Clarendon-place, Leamington, William

Gillard, Surgeon (retired), aged 69.JAMISON.—On the 4th inst., at Ranfurly-terrace, Dungannon, George

Jamison, L.F.P.S.G., aged 66.KEALY.—On the 5th inst., at Lawrence-street, Drogheda, John Leonard

Kealy. L.R.C.P.Ed.LAW.—On the 2nd ult., at Belize, Dr. William Law, late of Roadhead,

Lochwinnoch.MACKAY.-On the 3rd inst., at Rosedale, Yorkshire, William Murray

Mackay, L.R.C.P.Ed., aged 43.POPE. -On the 4th inst., at Brislington, Keynsham, Charles Pope,

Ext. L.R.C.P.L., aged 77.SQUIRES.—On the 21st April, at Nelson, New Zealand, William West-

brooke Squires, M.D., aged 36.WESTALL.—On the 10th inst., at Holland Villas-road, Kensington,

Edward Westall, F.R.C.S.E., aged 70.

[N.B.—A fee of 5s, is charged for the insertion of Notices of Births,Marriages and Deaths.]

BOOKS ETC. RECEIVED.

Dr. C. M. Kletke : Die Medicinal-Gesetzgebung des DeutschenReichs.

J. Marshall: Anatomy for Artists.Dr. Moriz Benedikt: Kraniometrische Mittheilungen.Dr. E. Schwimmer: Idiopathischen Schleimhautplaques der

Mundhöhle.Dr. Joseph Farrar : Baths and Bathing.Transactions of the American Medical Association. Vol. XXVIII.

1877.J. Hutchinson: Lectures on Clinical Surgery. Vol. 1. Part I.British Journal of Dental Science. May.The Australian Medical Journal. September, 1877.The Practitioner. June.

Notes, Short Comments, and Answers to

Correspondents.UNVACCINATED CHILDREN IN STEPNEY.

A RECENT sharp outbreak of small-pox in that portion of the parish ofRatcliffe situated south of the Commercial-road, induced the guardiansof Stepney to institute a house-to-house visitation, with a view tc’secure the vaccination of all unvaccinated persons. Excluding 78 un-vaccinated infants aged under three months, no less than 57 children,aged between three months and fourteen years, were found to be un-vaccinated within this very small area. Unfortunately we are not toldwhat proportion this number bore to the total children at these ages ;but it is highly important to know how, under our so-called com-pulsory vaccination system, it was possible for so large a number ofchildren to escape its operation. Local Government Board reportstell us that only five per cent. of the children born in London in recentyears escape successful vaccination; but the result of house-to-housevisitations, and of inspections of children in metropolitan elementaryschools, somewhat discredit the evidence of these reports. It is satis-

factory to learn that nearly all the unvaccinated children discoveredat this Stepney visitation have since been vaccinated; but this rendersit none the less important to ascertain where these 57 children wereborn, and how they evaded the provisions of our compulsory vaccina-tion system. Such facts help to explain the repetition of small-poxepidemics in London.

One of Eleven Yeccr,’ Service is thanked for his communication on thesubject of the drawbacks to the Indian medical service.

Lex.-We fear he has, in the absence of any stipulations to the contrary.

DIPHTHERIA IN ABERYSTWITH.

To the Editor of THE LANCET.

SIR,—I regret having to again make a distinct denial of your statementrespecting the recent prevalence of diphtheria in Aberystwith, "whichwas based upon the authority of the Registrar-General’s last QuarterlyReturn." Now, luckily for me, you have resorted to figures, which, in-stead of verifying, completely refute your remarks, and substantiatemine. You say that "the Registrar-General reported that of 12 fatalcases of diphtheria registered during the quarter in the registration sub-district of Aberystwith, 11 occurred in Aberystwith," and that you " arequite at a loss to account for my having failed to find the cases." I amstill at a loss, and I expect you will also be when I furnish you with theinformation that none of the 12 cases you mentioned, excepting one,occurred in Aberystwith, and that is the case in High-street, which Ireferred to as being the only case that occurred during the past quarter,and which was brought from a neighbouring village-viz., Penparke.You acknowledge that of 11 cases described as occurring in Aberystwith,3 were in Penparke, 5 in South-gate, 1 in High-street, 1 in Bridge-street,and 1 at the Dinos Hotel. The above-named places, I must inform you,are not streets in Aberystwith. 1st. Penparke is a village situated oneand a half miles from Aberystwith on the south side of the river Rheidol,which intervenes between the two places. 2nd. South-gate is a turnpike-gate at the extreme south end of the village of Penparke, and still furtherfrom Aberystwith ; there are only four houses at the South-gate, but the5 cases occurred in the same house. 3rd. Dinas Hotel is a small road-side inn in the Penparke-road, and exactly one mile from Aberystwith.Now, may I ask, where in Aberystwith did 11 cases of diphtheria occur,if you consider Penparke, South-gate, and Dinas Hotel as parts ofAberystwith? You may as well, and with greater justice, considerLewisham, Ladywell, and the Brockley Jack as New Cross. In the lattercase there is a certain unbroken chain of communication; but betweenthe town of Aberystwith and the village of Penparke there is none,there being but one house-viz., the Dinas Hotel-on the roadside be-tween the two places, which is a mile and a half in extent.Now that you are in possession of this information, I trust that you

will abandon the idea " that there can be no question as to the sharpoutbreak of epidemic diphtheria in Aberystwith during January andFebruary, and that it will suffice to justify my denial of your erroneousstatement, based upon the Registrar-General’s report, which is incorrectif it implies that 11 fatal cases of diphtheria occurred in Aberystwith, oreven within a mile of the town. I have it to-day, upon the authority ofDr. Gilbertson, that in his experience, which extends over thirty-fiveyears, however severely epidemics may rage in the country villages,the town of Aberystwith had always enjoyed a remarkable immunity.

I am, Sir, yours &c.,Aberystwith, June 4th, 1878. T. D. HARRIES.

’’’,’ Our correspondent appears to ignore the legal boundaries of theborough and urban sanitary district of Aberystwith, and to havesome more or less indefinite idea as to what is, or should be, calledAberystwith. We presume he would not limit it to the High-street,although he excludes Bridge-street. It is beyond dispute that all theeleven fatal cases of diphtheria in January and February last occurredwithin the borough of Aberystwith, although Penparke and South-gate,where most of the fatal cases occurred, appear to be situated about amile from the centre of the town. The Town Council of Aberystwith,as the urban sanitary authority, is, moreover, responsible for the con-dition of these villages, which our correspondent has described as"filthy." It may be doubted whether the sanitary authority, in fixingthe salary of their medical officer of health at .t50 per annum, showssufficient appreciation of the value of the health-reputation ofAberystwith.-ED. L.

886

VITAL STATISTICS OF NEW YORK. emerged from the pelvic cavity, the patient went forth from her chamberTHE Deputy Registrar of Vital Statistics of New York reports the of languishing, and passed the remainder of pregnancy fairly nourished,number of births in the city during 1877, according to the returns, to and in comparative comfort and strength. The offspring of this lady’sto first and third pregnancies were girls, and these periods were passedhave been 25,569 only. As the number of deaths in the same period through without unusual reflex disturbance. Her fourth confinement iswas 26,194, a very serious problem presents itself to all who are in- expected in June, and for nearly four months of her present pregnancy,terested in keeping up the population of the Empire City. Some con- the experience of continual nausea, loathing of food, vomiting, and pros-solation may, however, be derived from the circumstance that a strong

tration has been repeated with nearly or quite as great severity as five...’ .. years ago, mitigated only as I shall presently describe. First, however,

suspicion exists that a considerable number of births are not reported I wish to speak of the state of the womb as I found it in the latest preg-to the department. During the year in question a striking diminution nancy, and to commend to any of the gentlemen who have theories toin the mortality from small-pox was observed, while generally the substantiate a comparison of the conditions found in this lady’s case inrecords of the health department show an improvement in the sanitary the two pregnancies here described. bly own experience of this dis-

.. tressing trouble affords me as yet no theory beyond the demonstratedcondition of New York. and now universally admitted position that the malady is of reflexA Surgeon-Major.-The Dublin professors probably have in view the origin. The symptoms being the same in the two pregnancies, I mightdeficiencies of their own pupils when they wrote their advice about perhaps reasonably have inferred a similar local condition ; but, not

classics and science. We trust the new Bill will their advice about trusting to inferences in such matters, I investigated. Instead of retro-classics and science. We trust the new Bill will level them up to the version, I found the uterus in normal position ; instead of a straightstandard of the English schools. We are of opinion that the medical cervix, I found the cervix anteflexed at an angle with the uterine bodyofficers are at least on a par with the majority of the other officers of 70° or 80°; instead of a full, soft, patulous os, I found one small,on these subjects. Until a very few years ago they were much above rigid, and unyielding. Here was a test case for more than one method

on these subjects. were much theory. In the interval, however, between the patient’s first tryingthem ; but the general education of the officers of the army has been experience and the present one, I had successfully made use of warmraised to a much higher standard than formerly. vaginal lavements in several severe cases of the same malady, and I

Dr. Richard Caton.—The paper shall be inserted in an early number. therefore lost no time in recommencing them to her. These lavements,Dr. Richard Caton.—The paper shall be inserted in an early number. besides being very often efficacious, have this great merit, that thepatient may use them alone, or with the aid of her nurse only, and with

THE YOMITING OF PREGNANCY AND ITS TREATMENT actual comfort, and is spared the infliction of the surgeon’s armamentaritcTHE VOMITING OF PREGNANCY AND lib TREATMENT. and personal presence. It is a means which may be employed quite

To the Editor of THE LANCET. empirically, and often proves of value in relieving all degrees of reflex._,.... , , disturbance, even when no local deviation from the normal state can beSIR,—I ask a brief space in your columns for some remarks on a detected, and when no theory of causation has been formulated in the

subject which has been much discussed of late-namely, the vomiting mind of the attending physician. My patient tried the lavements faith-Qf pregnancy and its treatment. fully and perseveringly-at first with confidence, for they helped her;The method by application of nitrate of silver to the os and cervix then, after two or three days, with perplexed hopefulness, for she could

- not depend on their bringing relief; finally with mere doggedness, foraiteri proposed by Dr. Jones, of Chicago, and published in your issue she got no good from them. I now decided that the time was come toof February 23rd last, is not new, nor is it always effectual, as later try the plan of dilatation of the cervix by the finger, as practised by Dr.communications in your pages have well shown. The same qualifications Copeman. I explained it to the patient, and received her reluctant con-also apply to the method advocated by Dr. Edward Copeman in the sent. Three times, on three different days, I tried as persistently andBritish Medical Journal two or three years ago—a method neither forcibly as I dared, with right hand on the fundus uteri, and left index-British Medical Journal two or three years ago-a method neither finger pushed against the os, to dilate it, but without the least avail;original nor of very wide application. and while there resulted no remission of the refiex disorder, which was

All the theories which have been advanced to explain the modus pitiable, there was added for several days the suffering from local irrita-.operctrtdi of any of the per vaginam methods may easily be shown by the tation which my manipulations had produeed. In the meantime, left tohistories of true cases to be inadequate. These methods are still chiefly

her own unhappy reflections, the lady revolved in her mind what I hadhistories of true cases to be inadequate. These methods are still chiefly explained to her of the reflex nature of her misery, and of the anti-empirical, though embodying some dim scientific notions. cipated soothing influence of the local use of warm water; and one day

Patients dislike, and may refuse, to be experimented upon by any she asked me if I did not think it possible that warm olive oil mightsurgical procedure, especially when the scientific and conscientious succeed with her, though water had failed. I replied that it might,practitioner cannot honestly declare it to be clearly indicated, and rea- though I doubted it, since I supposed the influence of the two agents sopractitioner cannot honestly declare it to be clearly indicated, and rea- used would be much alike. She tried the oil, and was relieved. She- sonably sure to succeed ; but this difficulty does not appear against the continued its use, remaining most of the time in the horizontal position,use of certain local means, likewise empirical perhaps, but not in- favourable to keeping the os and cervix bathed in the lubricating fluid.trinsically disagreeable to the patient, and wholly manageable by her- During the three or four weeks that remained to her before the ascent

self, without aid from the medical attendant. of the uterus from the pelvic cavity, she was enabled to purchase com-self, without aid from the medical attendant. fort, and the power to leave her bed, eat, and retain food at the price of

I propose as briefly as possible to illustrate these propositions. using olive-oil vaginal injections two or three times daily.Nineteen years ago (Aug. 25th, 1859) Dr. E. D. Miller published in the I may add that my belief in the value of warm water lavements in

Boston Medical and Surgical Jourrtal (vol. lxi., p. 69), at the request of excessive vomiting of pregnancy, founded on sufficient experience, is not

his district Medical Society, a paper, narrating in detail the history much impaired by their failure in the above-told case, though I willinglyhis district Medical Society, a paper, narrating in detail the history of admit the use of olive-oil injections as an alternative. It is very possiblesix cases of dangerous vomiting of pregnancy successfully treated by that other practitioners have used both these expedients; but I havepainting the os and cervix uteri with a strong solution of iodine in seen no mention of them in medical publications, except an incidental- ether allusion made by the writer of this letter two or three years ago in a

The next following year the late Professor C. E. Buckingham read to communication to the Boston Medical and Surgical Journal. The thoughtThe next following year the late Professor C. E. Buckingham read to communication to me from observing the value of warm vaginal lavementsthe Boston Society for Medical Observation (reported in the Boston in allaying both local and reflex irritation when used in cases of inflam--4re,dical and Surgical Journal, Oct. 11th, 1860, vol. lxiii.) a case of exces- matory disease of the uterus, as recommended by Dr. T. Gaillard Thomassive vomiting in the seventh month of pregnancy, where it was agreed in his work on the Diseases of Women.in consultation, as a last resort, to procure abortion. A sponge-tent was It is desirable that the patient lie on her back, and receive the lave-in consultation, as a last resort, to procure abortion. A sponge-tent was ment with a gentle, continuous flow to the amount of three or fourintroduced; but though labour did not ensue, the vomiting was relieved. quarts once or twice daily. The most convenient apparatus consists of aTwelve days later the distressing symptoms returned with violence, bed-pan and a "fountain syringe," so called-that is, a rubber bag sus-when a sound was swept around between the womb and membranes pended as a reservoir, with several feet of rubber tubing, and a glass orand another tent inserted. This proceeding was followed by relief of metallic vaginal tube. Bed-pans are made here with a small, piercedand another tent inserted. This proceeding was followed by relief of neck at their bottom, to which a few feet of rubber tubing may bethe vomiting for three months and ten days longer. The trouble again attached to convey the water into a pail near the couch. It is generallyreturning, a uterine probe passed through the membranes procured the best to use water at a temperature as warm as can comfortably be borne.escape of a gill of water, followed by pains for twenty-four hours. Then Used with proper attention to details, for comfort and efficiency, I do

they ceased, and with them ceased all nausea and vomiting for the not believe there is the slightest danger of the production of miscarriage.they ceased, and with them ceased all nausea and vomiting for the Indeed I am sure that in some cases of pregnancy complicated with cer-

remainder of pregnancy. The patient was delivered of a healthy infant vicitis or with peri-uterine irritation resulting from earlier inflammation,remainder p pregnancy. The patient was delivered of a healthy infant vicitis or with peri-uterine irritation resulting from earlier inflammation,at full term, and made a good recovery. vaginal lavements have powerfully contributed to prevent impendingEleven years ago Dr. Francis Minot read to the Boston Society f or Medi- abortion. at more length than I intended; but I hope that therecal improvement (see same journal, vol. Ixxviii., p. 153) a case of uncon- I have written at more length than I intended; but I h ope that there

cal Improvement (see same journal, vol. lxxviii., p. 153) a case of uncon- is suggestiveness, if not other value, in all that I have presented, suffi-trollable vomiting in the third month, where every means failed until cient to justify the space occupied.the ovum had been expelled after three days’.use of dilatation by sponge- I remain, Sir, yours &c.,tents. Among the means employed in this case without material beneflt Dorchester, Boston, U.S.A., May 24th, 1878. J. S. GREENE.

were the application of solid nitrate of silver to the os and within thecervix, and three several paintings of ethereal tincture of iodine over the THE WESTMINSTER HOSPITAL SCHOOL.

os and cervix and upper part of vagina. Dr. Minot remarks that " as WE have been requested by the Dean of the above school to state thatthe patient had suffered from leucorrhoea since the beginning of preg- Mr. C. Brooke, F.R.S., is still a lecturer on the staff of the school, andnancy, much was hoped from these applications, although no dtsease was has not retired, as reported in Sir H. Thompson’s paper published invisible about the os or cervix." our last number.Five years ago a patient of mine, pregnant with her second child, a Pater.-It will be compulsory to pass the examination of the Conjointboy, was from near the beginning until the fifth month so utterly Board; or rather, passing it will be the only way of obtaining a quali-wretched and prostrated by continual nausea and persistent vomiting Board; or rather, passing it Will be the only way of obtaining a quali-

that I had serious fears for her safety. All the approved medicines were fying certificate under the Act, which will be the only title to regis-tried without avail, and a thorough use of iodine upon cervix and vagina tration after the Bill becomes law. A degree, medical or surgical, ofproved equally unsuccessful. Retroversion being present, I replaced the a University, acquired after the passing of the Act, will not entitle theuterus, and maintained it in position by a Hodge’s pessary, but without holder to bs registered.

’

the least apparent advantage. The cervix was straight, and the os large, soft, and somewhat patulous, with slight erosions. When the uterus Nemo is thanked; but we do not care to notice the matter.

887

LIABILITY OF PRINCIPALS FOR MALPRAXIS OF ASSISTANTS. A Medical Officer.—We do not see in what better manner promotion byB. V.—A master is not criminally responsible for the acts of an assistant, selection could be conducted. We are not surprised at his Royalunless he expressly command or personally co-operate in them. A Highness’s "dread" of making promotions by selection, if we may

master is, however, as a rule, civilly liable for the wrongful acts of an judge of’the principles on which he selects by the few cases whichassistant, unless they be beyond the ordinary scope of his employ- have come under our notice. We should be sorry to publish the latterment. The above statement is from the abstract of the principal laws part of our correspondent’s communication, seeming, as it does to,us,affecting the medical profession in the Medical Directory. to cast a slur upon the honesty of the medical officers generally.

Brigadier.-l. The Regulations were issued with the Army Circular for Volunteer Surgeon should apply to the Inspector-General of Volunteers

December, 1877, and January, 1878, and may be obtained from Har- for the information desired.

rison and Sons, Pall-mall. - 2. Apply to the Inspector-General of A physician and Surgeon.-No qualification obtained from a College ofVolunteers.—3. Yes. Physicians can confer the right to assume the title of "doctor."

Mr. Orr.—We cannot supply the information required. ., Market Rasen, (Lincolnshire,)-Letter sent incomplete, and without.jff. Orr.—We cannot supply the information required, enclosure.

BEEF-TEA.LIGATURE OF INTERNAL HÆMORRHOIDS; FATAL RESULT. To the Editor of THE LANCET.

To the Editor of THE LANCET. SIR,-In making beef-tea it is well not to add the water to the meat

SIR - February last a youth of about eighteen years of a e until the latter has discharged all the gravy from its fibre under the in-SIR,-In February last a youth of about eighteen years of age, a fluence of moderate heat. Cut or tear an ordinary beef-steak to pieces on a.Buniah by caste, requested me to operate upon him for the cure of dish, using a knife and fork, and reducing it to somewhat small fragments ;haemorrhoids, from which he said he had been suffering for the last six then throw the meat into a jar, and close the top with an earthenware

years. The boy was in the last stage of anaemia ; his face and hands cover, or paper stretched over it, and tied. In any case keep in the steam.blanched, the surface of the skin cold and clamm and the pulse almost

Place the jar in a slow oven, or set it on the top of a boiler, or, still’blanched, the surface of the skin cold and clammy, and the pulse almost better, stand it in a saucepan of hot water, not boiling. Be careful thatimperceptible. He walked and stood with great difficulty, and was no water reaches the meat. After standing for about three-quarters ofevidently in a state of extreme prostration. On his protruding the piles an hour, exposed to a moderate temperature, hot enough to melt the softat my request, a ring of very vascular, strawberry-shaped haemorrhoids parts of the meat, but not to coagulate it, remove the cover, and pour onwas seen to surround the gut within the sphincter, and a good-sized water below the boiling point in the proportion of one pint to a poundartery jetted whilst they were exposed. As the case was one of life or of the meat; add a little salt, and let the contents of the jar now simmerdeath, I recommended immediate operative interference, and without an hour, and strain through a coarse cloth, squeezing the residue, whichdelay I ligatured the piles through their bases in four sections. The will be found to consist of indigestible fibre, while the "beef-tea" is.operation was done at the patient’s own house, as he refused to enter strong and good. Yours &c.,the Civil Hospital. The ordinary after-treatment was pursued: com- June 10th, 1878. A PRACTICAL PHYSICIAN.plete rest and an opiate suppository. On the evening after the opera- P.S.—Biscuit-powder or grated toast may be mixed with the beef-teation the patient was fairly comfortable, only complaining of pain on P.S.—Biscuit-powder or grated too may be mixed with the beerishamicturition. There was slight heat of skin, as might have been in cases where the stomach is not too irritable, and farinaceous nourish-expected. The following day the patient remained in the same state, ment is required.and there was no occasion to be anxious. On the third morning after To the Editor of THE LANCET.the operation I was sent for very early, as the boy was said to be very SIR,-I am sorry that it should " fall to the lot" of L. R. H. to pre-ill. I found him delirious, but capable of being roused when spoken to. scribe a large amount of beef-tea. Of course one cannot avoid giving itHis eyes were firmly closed, and he was very restless, with a hot skin sometimes, but I think, where it can be done, milk should be given inand rapid pulse. There had been no bleeding since the operation. The preference. I attend a workhouse infirmary with 130 beds. and I don’tsame evening he was quite unconscious, and incapable of being roused, think half a dozen pints of beef-tea are consumed there daily. Therebut he was not so restless ; his eyes were still kept shut. There were no seems to be a good deal of ignorance amongst the public, and in theconvulsions or rigidity, or, on the other hand, any symptoms of hemi- profession, too, as to the nutritive value of this article of sick diet. Byplegia. His breathing was quiet, but the skin was still hot, and the itself " its effects are due chiefly to its warmth and pleasant taste, andpulse very rapid. I may say here that after the operation the latter it enables one to take a larger amount of dry and tasteless food." (Brit.somewhat improved. The patient never rallied or became conscious, Med. Jour., vol. i., 1872, p. 480.) It is " a food to a very limited extent,and died during the night. No post-mortem could be performed, and but an agreeable stimulant." (Practitioner, vol. i., 1875, p. 445.) Liebig’sthe cause of death must be left to conjecture. extract given alone is merely a stimulant. This and ordinary beef-tea,When death occurs after the operation for the cure of hasmorrhoids, when mixed with farinaceous foods, are probably suitable aliments, but

whether by ligature or cautery, it does so by the occurrence of pyaemia, they can never be equal to milk. Without going further into this ques-In this case the patient died with distinct head symptoms, which were tion, I may refer your correspondent to " Fothergill’s Practitioner’smore those of encephalitis than anything else. I must confess I am at a Handbook of Treatment," " Chambers’s Manual of Diet and Regimen,"loss to account for the extraordinary termination of this case. and " Chambers’s Indigestions," for some valuable remarks on beef-tea,

Yours &c., and for the quantity of meat required per pint he will find recipes inEDWARD COLSON. many works-one I may mention is "Ringer’s Therapeutics."

May llth, 1878. Surgeon, Bombay Army; Civil Surgeon, Dhulia. I am, Sir, yours &c.,Cardiff, June 10th, 1878. ALF. SHEEN, M.D.

Mr. George Coates.-Information may be obtained of Mr. Holthouse, To the Editor of THE LANCET.15, George-street, Hanover-square ; or our advertisement columns may SIR,—With reference to the preparation of beef-tea, I would suggestbe consulted on the subject. the following recipe to the consideration of your readers as one which

L.R.C.S. Ed. will see the question has been proposed by another corre- furnishes the most nutritious, and perhaps the least expensive, alimentL.R.C.S. Ed. will see the question has been proposed by another corre- of the kind for invalids :-Take one pound of neck of beef, chopped veryspondent, and is under discussion. finely so as to resemble "sausage-meat," and add to it one pint of cold

water ; set aside, and allow it to soak for twelve hours ; then gently andWHY SHOULD THE SOCIETY OF APOTHECARIES BE steadily heat, or, what the cook calls, simmer, for two hours; strain

CONTINUED AS AN EXAMINING BODY? through a coarse sieve, a cullender, and it is ready for use. For those,CONTINUED AS AN EXAMINING BODY ? however, who have a great distaste for fat, or with whom it appears to

To the Editor of THE LANCET. disagree, the beef-tea must be allowed to cool, and the fat removed_ _ .. from the surface. It may be flavoured with mace, nutmeg, pepper, &c.,SIR,-I venture to propose the above question, not as a new one, for according to taste. It may Yours faithfully,

it must often have suggested itself to others, but on its own merits at Middlesex Hospital, June, 1878. T. FREDK. PEARSE, M.D., &c.this particular time, when so much is said and written about medical To the Editor of THE LANCET.

reform. It is quite true that by occupying the field under the Act of SIR,—In answer to the questions put by " L. R. H." in your last1815, when the College of Physicians shrank from performing an obvious number, I may quote the formula used at this infirmary :-Beef-tea, toduty, the Society has done good service to the public and the profession, make one pint: Shin of beef chopped fine (without bone), one pound;and has had a large share in raising the standard of education for cold water, one quart. Simmer gently to one pint. With reference togeneral practitioners. But now that the College of Physicians has his third query, as we never use the extract of meat, I am unable toopened its portal to the licentiates, who under its sanction now occupy give the information desired -I am, Sir, yours truly,a highly honourable position, and are thereby made eligible for most Infirmary, St. George-in-the-East, Middlesex, RIDLEY DALE,ordinary official posts, the raison d’être of the Apothecaries’ Company June 10th, 1878. Assist. Med. Officer.has ceased to exist, and it may truly be said of them that nothing would M.R.C.S.—1. The de ree mentioned will be reg istrable or not at the dis-better become them than an act of "happy dispatch." As this, however, M.R.C.S.1. The degree mentioned will be registrable or not at the dis.is not a very probable occurrence, it remains chiefly with the members cretion of the Medical Council.-2. They are not empowered to use itof the profession to give a direction to public opinion. This they have now. It will be declared illegal in the new Act to use any title notmany opportunities of doing, as, for instance, by the course they pursue warranted by the nature of the degrees or siplmnas possessed.-3. No.in the education of their own sons and relatives, in the advice they can 4. Yes; the Durham University and the St. Andrews University do.give when consulted by the parents and guardians of young men about 4. Yes; the Durham University and the St. Andrews University do.to enter the profession, and to boards of guardians and other public Stgma. - The examination is very simple and practical. About £50bodies having to make appointments. If the profession were steadily to should cover the cost of outfit.set their face in opposition to the licence of the Company as a qualifica-tion for practice, and to direct the current of public opinion in the TREATMENT OF ACNE ROSACEA.direction of the licence of the College of Physicians, as most suited for To the Editor of rr LANCET.those about to become general practitioners, and to whom the expense To the Editor of THE LANCET.and time necessary for obtaining the title of M.D. is a serious obstacle, SIR,-I should recommend your correspondent to advise his patient tonot many years would elapse before the business of the Company in wash his face several (say six) times a day, using very hot water andgranting licences would collapse by sheer inanition, and become a thing plenty of soap. If this causes much irritation, he should afterwardsof the past, whilst it might continue to prosper as a trading body. In apply a little bland oil (almond). I have found this plan of treatment in-that way an obvious anomaly would be removed, which is in many ways s such cases very efficacious, and in a very short time. This plan of treat-objectionable, and in none more so than in its tendency to lower the ment requires a little courage at the first ; but if persevered in for a fewsocial status of the profession by associating it with the ideas attaching days, success, I think, is sure to follow.to a mere trade. I am, Sir, yours &c., I am, Sir, yours truly,June 5th, 1878. F.R.C.S. Eng. Brighton, June 11th, 1878. J. M. E. SCATLIFF, MD.

888

Cosmopolite.-The new Medical Bill will not forbid the use of the title,which, indeed, is not illegal at present in the circumstances. TheMedical Bill gives power to the Medical Council to recognise andregister foreign medical degrees of which it approves.

Veritas, who addresses us on the subject of Medical Titles, has forgottento enclose his card.

Mr. Owens.-We are obliged for the communication, but have not spaceto print it.

NURSING IN WORKHOUSE INFIRMARIES.To the Editor of THE LANCET.

SIR,—In the year 1867, by Gathorne Hardy’s Act, the sick paupers ofthe metropolis were placed in infirmaries under the control and super-vision of medical men, and the scandals which roused the public at thatperiod were to a great extent, if not altogether, relegated to the past,and the pauper sick were treated as human beings.One of the great reforms brought about by this Act is the substitute

of paid for pauper nursing. Still this system as at present arranged isby no means as perfect as it might be. Under the present system, thematron, the nurses, and assistant-nurses are appointed by the Board ofGuardians, and can only be dismissed by them. What is the result ?Not unfrequently most unsuitable persons are appointed, and on theirbeing reported to the Board of Guardians for incompetency or neglectof patients by the medical officer, they are mildly reproved, and thusthoroughly incompetent persons are kept in situations of the greatestimportance to the welfare of the sick. I have known instances ofdrunken women being kept in their situations as nurses for two andthree years, notwithstanding the repeated remonstrances of the medicalofficer. Ought there not to be a remedy for this state of affairs ? Oughtnot the nursing of the sick paupers of this metropolis be as much placedunder the control of the medical officer as the diet, stimulants, physic,ventilation, warming ? For is not efficient nursing as important as anyof these other remedies ? And how is it to be obtained if improperpersons are kept as matrons or nurses ? The remedy I suggest is, thatsome regulations be framed by the Local Government Board, strength-ening the medical officer’s opinion, or causing him to report directly tothem. Now, I am not suggesting anything very novel, for it is to a largeextent carried out in lunatic asylums, and those asylums are the bestmanaged where the medical superintendent has absolute power andcontrol, but where the Committee governs, as a rule, anarchy prevails.The question I have raised is, I believe, an important one, and I trust

you will allow a discussion of the subject in your columns.Yours truly,

June 4th, 1878. M.D.

ERRATUM.-In the paragraph on p. 853 of our last issue, announcing theelections into the Royal Institution, for " J. Lawrence-Hamilton, M.D.,"read, J. Lawrence-Hamilton, L.R.C.P.Ed.

COMMUNICATIONS, LETTERS, &c., have been received from-Mr. Bellamy,London; Dr. R. H. Goolden, London; Mr. Illingworth, Peterborough;Dr. Pearse, London; Mr. MacGregor, Inverness; Dr. R. Caton, Liver-pool ; Dr. Hope, York, Western Australia ; Dr. Weir, Leicester;Dr. Nicholls, Chelmsford; Mr. Corder, Brighton; Mr. G. A. Brown,Tredegar; Dr. Macewen, Glasgow; Mr. Wilson, Plymouth; Mr. Bull,Stony Stratford; Mr. Deakin, Allahabad; Mr. Theobald, Leicester;Mr. Dale, London; Mr. J. F. Smith, London; Mr. Pendred, London;Dr. Wake, London; Mr. Meikle, London; Mr. Steel, Lewisham;Dr. Senftleben, London ; Mr. Oliver, Manchester; Mr. Orr, Kirkstall;Mr. Greene, Beverley; Mr. Cooper, Aden; Messrs. Dadabhoy and Co.,London; Mr. Kingzett, London; Mr. Startin, London; Dr. Owen,Tynemouth; Mr. Potter, London; Mr. Phillips, Reading; Dr. Taylor,Bradford; Mr. O’Leary, Birmingham ; Dr. Farley, Gilroy, California;Mr. Scott, Penrith; Mr. Morton, New Brompton; Mr. F. Manby,Brandon; Mr. Drayton; Mr. Reed; Dr. Davies ; Mr. White, Chiswick ;Mr. Elliott; Mr. Owens, East Farleigh; Mr. Van Abbott; Dr. Scatliff,Brighton; Dr. Harries, Aberystwith; Dr. Gillespie; Mr. Parrott;Dr. Sheen, Cardiff ; Mr. Hine, Sheffield ; Dr. Gray, Oxford; Messrs.Field; Dr. Chaplin, Jerusalem ; Mr. Price; Dr. Redwood, Rhymney ;Mr. Ling, Saxmundham; Dr. Coates, Warkworth; Mr. W. W. Smith;Mr. Westley; Mr. Fawcett ; Mr. T. Cooke; Dr. Eberle; Candidate;The Dean of Westminster Hospital Medical School; Lex; M.R.C.S.;A Surgeon-Major; A Medical Officer ; One of Eleven Years’ Service;Pater; W. T. L. ; Volunteer Surgeon; Brigadier; N. Z. ; L.R.C.S. Ed.;Q. H., Norwich; A Physician and Surgeon ; The Registrar-General ofEdinburgh; Nemo ; The Registrar-General of Edinburgh ; Medico ;Spero Meliora; M.D. ; The Registrar-General of Births &c. ; &c. &c.

LETTERS, each with enclosure, are also acknowledged from - Mr. Smith,Burnley ; Mr. Bisshopp, Tunbridge ; Mr. Duke, Wells; Mr. Ambler,Hemel-Hempstead; Mr. Scott, Penrith; Mr. Vavasour, Liverpool;Mr. Bull, Cambridge ; Dr. Mackey ; Mr. Taylor ; Dr. Bentley, Rich-mond ; Mr. Anstie; Dr. Bain, Bristol; Dr. Bower, Northampton;Mr. Jenkinson; Mr. Walker, Dudley; Dr. Todd, North Petherton ;Mr. White; Mr. Britnell; Mr. Ayres ; Mr. Thomas ; Mr. Vallance ;Dr. Brady, Derby ; S. S. B., Bishop-Stortford; M. B. A., Edinburgh;T. F., Oldham; Surgeon, Ballycastle ; J. R., Bromley; J. P., Leicester;0. P. ; G. G. ; J. R. S.; Medicus, Edinburgh; Beta; Librarian; Z. ;Medicus, Manchester; P. M.; G. S.; D. M., Tutbury; Employer;Alpha; Fides; A. B., Llanfyllin ; D. T. C. ; M., Sittingbourne; Percy,Poplar; M. B., Chesterfield; M.R.C.S., Great Grimsby.

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,Stratford-upon-won Chronicle, Cambrian, Freemason, Hastings andSt. Leonard’s Times, Dublin Evening Mail, Colonies and India, MadrasMail, Runcorn Guardian, Retford and Gainsborough Times, North andSouth Shields Daily Gazette, Shrewsbury Chronicle, &c., have beenreceived.

Medical Diary for the ensuing Week.Monday, June 17.

ROYAL LONDON OPHTHALMIC HOSPITAL, MOORFIELDS. - Operations,10 A.M. each day, and at the same hour.

ROYAL WESTMINSTER OPHTHALMIC HOSPITAL.—Operations, 1½ P.M. eachday, and at the same hour.

ST. MARK’S HOSPITAL.-Operations, 9 A.M. and 2 P.M.METROPOLITAN FREE HOSPITAL.-Operations, 2 P.M.ROYAL ORTHOPEDIC HOSPITAL.-Operations, 2 P.M.ROYAL COLLEGE OF SURGEONS OF ENGLAND.-4 P.M. Professor T. Spencer

Wells, "On the Diagnosis and Surgical Treatment of AbdominalTumours."

Tuesday, June 18.GUY’s HOSPITAL.-Operations, 1 P.M., and on Friday at the same hour.WESTMINSTER HOSPITAL.-Operations, 2 P.M.NATIONAL ORTHOPEDIC HOSPITAL.-Operations, 2 P.M.WEST LONDON HOSPITAL.-Operations, 3 P.M.ROYAL INSTITUTION.-3 P.M. Rev. W. H. Dallinger, " On Researches in

Minute and Low Forms of Life."

Wednesday, June 19.MIDDLESEX HOSPITAL.-Operations, 1 P.M.ST. MARY’S HOSPITAL.-Operations, 1¼ P.M.ST. BARTHOLOMEW’S HOSPITAL. - Operations, 1½ P.M., and on Saturday

at the same hour.ST. THOMAS’S HOSPITAL. - Operations, 1 P.M., and on Saturday at the

same hour.KING’S COLLEGE HOSPITAL. - Operations, 2 P.M., and on Saturday at

1 P.M.LONDON HOSPITAL.-Operations, 2 P.M., and on Thursday and Saturday

at the same hour.GREAT NORTHERN HOSPITAL.-Operations, 2 P.M.UNIVERSITY COLLEGE HOSPITAL. - Operations, 2 P.M., and on Saturday

at the same hour.SAMARITAN FREE HOSPITAL FOR WOMEN AND CHILDREN. - Operations,

2½ P.M.ROYAL COLLEGE OF SURGEONS OF ENGLAND.-4 P.M. Professor T. Spencer

Wells, " On the Diagnosis and Surgical Treatment of AbdominalTumours."

Thursday, June 20.ST. GEORGE’S HOSPITAL.-Operations, 1 P.M.ST. BARTHOLOMEW’S HOSPITAL.-1 P.M. Surgical Consultations.ST. THOMAS’S HOSPITAL.-Ophthalmic Operations, 4 P.M.CHARING-CROSS HOSPITAL.-Operations, 2 P.M.CENTRAL LONDON OPHTHALMIC HOSPITAL. - Operations, 2 P.M., and on

Friday at the same hour.

Friday, June 21.ST. GEORGE’S HOSPITAL.-Ophthalmic Operations, 1¼ P.M.ROYAL SOUTH LONDON OPHTHALMIC HOSPITAL.-Operations, 2 P.M.ROYAL COLLEGE OF SURGEONS OF ENGLAND.—4 P.M. ProfessorT. Spencer

Wells, "On the Diagnosis and Surgical Treatment of AbdominalTumours."

Saturday, June 22.ROYAL FREE HOSPITAL.-Operations, 2 P.M.